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NHS Fife: Getting it right for our most vulnerable patients

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Mix of Competencies

Frailty Team Lead, Louise Kellichan explained:

“Comprehensive Geriatric Assessments look at the whole picture – physical and mental health, as well as social and environmental factors. This is so important and it has been shown to make a significant difference to patient outcomes.”

Prior to the formation of the Integrated Assessment Team, The Victoria Hospital had created a therapy and acute care of the elderly team to manage the admission of older patients. The teams were particularly effective at skill sharing, developing a diverse mix of competencies in each team member to equip them to care for frail older people. The new Integrated Assessment Team has continued with this approach, creating a matrix of compulsory training for all members of the team.

Joy commented:

“Frailty is a significant component of urgent care. Roughly seventy per cent of people who exhibit frailty symptoms are over the age of 65. If we can get it right for these vulnerable patients, we get it right for everyone.”

Frailty Team Lead, Louise Kellichan pointed out that having the data to support the change process was important for obtaining executive and staff buy-in. The 6 Essential Actions provided a valuable framework for our improvement process as it encompassed patient rather than bed management, seven-day services and using data to support and monitor improvement, all of which were key elements we aimed to deliver.

Monitoring the impact of service changes enabled the team to demonstrate to staff, particular detractors, that their work was making a real difference to patients.